Comparison of benefit between dabigatran and warfarin among patients with atrial fibrillation: A systematic review

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Amal K SuliemanDOI:10.4103/2045-080X.181039

Warfarin is recognized as the standard antithrombotic agent for stroke prevention. However, new oral anticoagulant such as dabigatran constitutes huge improvement to compensate for the limitation of warfarin. A literature review was performed to compare and contrast the overall benefit of dabigatran and warfarin among patients with atrial fibrillation. We utilized HighWire as the data source for randomized controlled trials based on inclusion and exclusion criteria (from January 2007 to September 2013). Descriptive and quantitative information related to stroke and major bleeding were extracted from each trial. After a comprehensive screening of 298 search results, 17 studies which enrolled a total of 127,594 patients were included. Warfarin was found to have higher mean event rates for incidence of stroke, major bleeding, and net clinical benefit compared to dabigatran 110 mg and dabigatran 150 mg. Dabigatran 110 mg has higher rate of stroke and net clinical benefit than dabigatran 150 mg with less major hemorrhage. Overall, dabigatran had higher efficacy and safety profile than warfarin. Further research is required to determine the clinical feasibility of dabigatran in real-life practice.

Objective: Electronic cigarette (e-cig) is recently growing substitute for smoking. The attention and practice of e-cig among consumers is expanded globally, and Malaysia is not an exception to this, but the paucity of local data motivates us to do the current research.
Methods: A total of 220 e-cig vapers recruited for the study and divided into two categories based on smoking status as a single user and dual user. Both users observed for 1 month period to assess smoking cessation rate, adverse effects, withdrawal symptoms, and smoking-related diseases.
Results: A month follow-up showed still 28.44% (P ≤ 0.001) of the entire study population (62 of 218, intention to treat analysis) were abstained from tobacco smoking. However, a high number of single user shown more quit rate as compared to of dual users (72.9% [51] vs. 7.4% [11]: Odds ratio 33.43; 95% confidence interval: 0.102–3.410) and merely two persons (<1%) started e-cig by ever smokers. The key adverse effects and withdrawal symptoms that observed in dual users were coughing, breathing problems, and craving, whereas in single users high appetite cases documented; however, no cases of any diseases reported among both users during the whole study period.
Conclusion: A month follow-up showed a good smoking cessation rate among Malaysian vapers mainly in single users, whereas less number of quitters but the high reduction in tobacco cigarette consumption observed in dual users without any harmful effects. Furthermore, extended period studies are warranted to confirm its long-term safety and effectiveness among different Malaysian population.

Objective: The aim of this study is to explore pharmacists' attitudes regarding pharmaceutical care in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients.
Methods: A cross-sectional questionnaire-based study was conducted among Saudi pharmacists between October 2012 and October 2014. A convenient sampling technique was employed in the five Saudi Kingdom regions: Central, West, East, North, and South. The target sample was 200 pharmacists based on a calculation of the power of sample with an 85% confidence level. SPSS, version 20®, was used to descriptively analyze the data. The Kruskal–Wallis test was applied to highlight the significant responses. A P < 0.05 was considered statistically significant.
Results: Of the 200 questionnaires distributed, 162 were completed; a response rate 81.0%. Based on the results, pharmacists in Saudi generally had positive attitudes and beliefs toward pharmaceutical care in CKD and ESRD due to a complicated disease state with multiple drug and nondrug therapies (69.1%); this finding indicated that this type of pharmaceutical care requires that more time is dedicated to patients (69.7%). The results showed that 40.8% of pharmacists were familiar with National Kidney Foundation-Kidney Disease Outcomes Quality Initiative clinical practice guidelines. Most pharmacists either agreed or strongly agreed that implementing this type of pharmaceutical care will have a positive economic impact on patients' families and the health system. The physician–pharmacist relationship is also considered to be a major barrier for pharmacist intervention given that physicians have primary responsibility for modifying the patients' treatment plans.
Conclusion: The contribution of pharmacists in CKD and ESRD will continue to grow as their clinical knowledge improves. Saudi pharmacists believe that the pharmaceutical care is an essential component of managing CKD and ESRD patients.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a commonly used class of drugs. They are used for self-medication worldwide including Nepal to treat self-limiting conditions, and mild to moderate symptoms associated with disease. Similar degree of care like prescription-only drugs is needed for these drugs as these are also linked with many adverse effects. However, nephrotoxicity remains a major concern with these drugs; other systems such as gastrointestinal, cardiovascular, hematologic, respiratory, and hepatic are also affected. The renal effects of analgesics are pronounced among patients with comorbid conditions, hypovolemic state of body and those with concomitant use of nephrotoxic or other drugs. A number of studies on self-medication all over the world have revealed that NSAIDs are the most commonly used drugs as self-medication. Easy access to these drugs either in pharmacy or in nonpharmacy outlets has become a reason for proper monitoring of over-the-counter use of these drugs. Responsibility remains with all healthcare professionals, either at individual or institutional level, to establish the balance between the benefits and risks associated with these drugs. The consumer who uses the drugs and the policy-framing bodies are others who could intervene in promoting the rational use of NSAIDs.

The diminution of CD4 lymphocytes is the diagnostic characteristic of human immunodeficiency virus (HIV) infection. Since the discovery of the disease 35 years ago, the infection has become one of the greatest menaces for the modern civilization. There are many individual drug toxicities and a number of class-specific or therapy-related toxicities of anti-HIV agents. Hepatotoxicity is a well-recognized side effect developing asymptomatic mild elevation of transaminases. It is known that the incidence of adverse reactions is high in long-term reactions such as lipodystrophy, paresthesia, and neuromotor disorders. Antiretroviral (ARV) therapy is not only effective but also complex. There are many adverse effects of the therapy, which affect varieties of the organ system. To optimize the treatment, health professionals should focus on preventing the adverse effect of ARV agents.